The University of Pittsburgh School of Medicine proposes to develop a four-year medical school curriculum in which each year makes the optimal, stage-appropriate contribution to effective and compassionate care of patients near the end of life. While the undergraduate medical curriculum by itself cannot prepare physicians to be experts in end-of-life care, it can instill an interest in giving such care, the basic knowledge, skills, and attitudes required for such care, and a desire to learn more. The major components of the proposal are: (I) to adjust the current medical school curriculum to take maximum advantage of presently existing opportunities to introduce end-of-life content; (2) to introduce a new curricular component to provide students with prolonged exposure to patients with life-threatening illnesses; and (3) to provide faculty development experiences to increase the number of clinical role models who practice and teach optimal end-of-life care. This is a step-by-step, incremental approach that pays equal attention to curricular change and to the knowledge base and teaching skills of the faculty, so that when students move from the preclinical to the clinical years of medical school, faculty role models will be in place to reinforce the enhanced end-of-life education the students will bring with them into their clerkships. The specific aims of this proposal are: (1) to increase students' scientific and humanistic knowledge related to end-of-life care: (2) to instill in medical students understanding and acceptance of the importance in the physician's role of providing effective and compassionate end-of-life care; and (3 ) to broaden the commitment of the clinical faculty to incorporating end-of-life content into their clinical teaching, and increase their awareness of the opportunities and methods for doing so. The present application concentrates on students' basic knowledge and attitudes toward end-of-life care, proposing modifications in Years 1 and 2 of the curriculum, and the faculty development process. A second application will concentrate on the relevant clinical skills and behaviors, by working with the enlarged pool of faculty role models and instructors to implement curricular changes in Years 3 and 4. We will measure the attainment of aims throughout the project using surveys, pre/post tests, course enrollment and attendance data, course evaluations, course examinations, objective standardized clinical examinations, written analyses of clinical scenarios, and de-briefing interviews.